Midwifery

Midwives cared for women during and after childbirth and provided advice on other problems related to female reproduction, including breast-feeding and infant care. They also served as general medical advisers and practitioners.

the work of midwives

The most common and well-known work of midwives was delivering babies. A woman in labor called the midwife when she entered what modern physicians call "active labor," the early stage of childbirth when the contractions become regular and strong. Usually the midwife would encourage the woman to remain active as long as she could at this stage, believing that activity such as walking made labor shorter. Midwives rarely used medicines, allowing nature to take its course.

In the system of "social childbirth" that dominated this period, births were attended not just by a midwife but by a group of female neighbors and relatives. At some point—usually when the birth seemed imminent—the woman or her husband would "call the women." The women took an active role in assisting the midwife. Often a woman gave birth supported on either side by other women; some accounts describe women delivering babies while seated on another woman's lap. Midwives sometimes used birthing stools, a horseshoe-shaped raised chair on which a woman could sit while giving birth, but even then the birthing woman would be held or supported by other women. The midwife's job was to catch the infant, cut the umbilical cord, and deliver the afterbirth.

After the birth and the delivery of the placenta, the midwife would wrap the mother's abdomen and legs with linen bands, a practice thought to prevent postpartum complications. Mothers would then "lie in" for a week or so to recover from the birth, but midwives rarely cared for their patients during this

time unless complications arose; instead, new mothers were attended by an "after-nurse," who could be a paid caregiver or an unpaid relative.

In addition to attending childbirth, midwives provided advice and remedies on breast-feeding and postpartum complications. Midwives supplied medicines to increase the flow of breast milk, made ointments for sore nipples, and sometimes even lanced breast abscesses. If childbed fever set in, as it sometimes did, midwives nursed the invalid and provided what medicines they could until the woman either recovered or died.

Although midwives were primarily birth attendants, their responsibilities often went further. Many midwives acted as general practitioners, making medicines, nursing the sick, and even setting broken bones. At a time when physicians were sometimes in short supply or beyond the purses of many patients, midwives filled the gaps in available medical care.

midwives' training

A midwife was typically a married or widowed woman past menopause who had borne children herself. Most often, she was of middling rank or class, although elite women also became midwives. All of these characteristics were considered crucial for midwifery. The midwife must be respectable and well-thought of by her neighbors, or they would not trust her; she must be past childbearing herself, or her own pregnancies and the care of young children would interfere with her duties; and she must have given birth in order to properly empathize with her patients.

Most midwives did not have formal education or training. Instead, they served informal apprenticeships with older midwives. Often this apprenticeship was as simple as merely attending many births as one of "the women," learning from the midwife, and gradually taking on more and more responsibility. Women also learned home remedies and herbal medicines from their older female neighbors and relatives, especially mothers and grandmothers. Such knowledge was passed down through families along with other household practices and family remedies.

midwives in non-european communities

Enslaved African American women also served as midwives. Like their European American counterparts, African American midwives provided general health care as well as obstetrical services. Slave midwives took care of their own families, their fellow slaves, and sometimes the white family as well, using herbal remedies and homemade medicines. They relied on oral traditions to learn their skills, although occasionally a master provided more formal training. On large plantations, masters often built specialized slave hospitals or infirmaries, with slave midwives and nurses in attendance.

Midwifery was one of the few specialized skills reserved for female slaves. As such, it sometimes conferred unusual privileges. Some slave midwives were called not just to their fellow slaves but to neighboring white families as well. As a result, they had unusual freedom of movement. Such mobility enabled midwives to see friends and relatives on other plantations and to act as messenger or go-between for other slaves. Midwifery could also be a source of outside income for an enslaved woman if her master allowed her to keep some of her fees. Because of their skill and their privileges, slave midwives were deeply respected in their communities. Their fellow slaves looked to them for wisdom as well as healing.

Less is known about Native American midwives. Research on Native American childbirth customs suggests that they, like other cultural practices, varied considerably from culture to culture. In general, Native American women were attended by other women, often kin, who assisted and supported the mother during childbirth. If a birth was complicated, a traditional healer or shaman might be called in, and in some tribes these healers were women. Shamanistic healers used sweat baths, herbs, roots, and prayer to ease the birth.

changes between 1750 and 1820

The years from 1750 to 1820 were a critical period in the history of midwifery. Shortly after the Revolution, male physicians trained in Europe began attending the births of wealthy urban women. Male physicians could offer services that midwives could not, specifically the use of forceps and painkillers such as opium. Patients felt these techniques made childbirth safer and less painful, and women who could afford to do so chose male physicians over midwives.

As time passed, physician-attended birth became more and more common, even in rural areas and among the middle class. At times, a woman called both a midwife and a physician to attend her. Midwives and physicians thus negotiated a delicate balance between traditional childbirth and the new physician obstetrics. What did not change, however, was the female domination and control of childbirth. As long as births remained in a woman's home, as they would until the early twentieth century, women remained in charge of their own birth experiences, and the tradition of social childbirth continued. Midwives themselves continued to practice throughout the nineteenth and twentieth centuries, although their practice became more and more marginal, often limited to remote rural areas, new immigrants, and the poor.

See alsoMedicine .

bibliography

Fett, Sharla. Working Cures: Healing, Health and Power on Southern Slave Plantations. Chapel Hill: University of North Carolina Press, 2002.

Leavitt, Judith Walzer. Brought to Bed: Childbearing in America, 1750–1950. New York: Oxford University Press, 1986.

Marie Plane, Ann. "Childbirth Practices among Native American Women of New England and Canada, 1600-1800" in Peter Benes, Ed. Medicine and Healing, Annual Proceedings of the Dublin Seminar for New England. Folk-life 15 (1990): 13-24.

Tannenbaum, Rebecca J. The Healer's Calling: Women and Medicine in Early New England. Ithaca, N.Y.: Cornell University Press, 2002.

Ulrich, Laurel Thatcher. A Midwife's Tale: The Life of Martha Ballard, Based on Her Diary, 1785–1812. New York: Knopf, 1990.

Rebecca J. Tannenbaum